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RRC230146-25 HENRY FORD HEALTH WYANDOTTE HOSPITAL (Active)
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Main Details
Name
HENRY FORD HEALTH WYANDOTTE HOSPITAL
Subdivision Name
HENRY FORD HEALTH CENTER - BROWNSTOWN - PATHOLOGY
Type
Rural Referral Center
Rural
Yes
340B ID
RRC230146-25
Medicare Provider Number
230146
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/16/2018
Participating Start Date
10/1/2018
Participating Approval Date
8/7/2018
Last Recertification Date
8/26/2024
Contacts
Authorizing Official
Henry Ford Hospital
Doug Clark, SVP - Corporate Finance
(313) 874-5446
Primary Contact
Henry Ford Hospital
Alexander Mansour, 340B Compliance Officer
(248) 723-0020
Addresses
Street Address
23050 WEST RD
BROWNSTOWN TWP, MI 48183-1472
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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